1. Field of the Invention
This invention relates to improved partial lung resection procedures and more particularly to improved methods of treating peripheral bronchopleural fistulas.
2. Description of the Related Art
In the United States, more than 30,000 lobectomies are performed annually in addition to numerous other partial lung resection procedures including segmentectomy, wedge and bleb resection. Prolonged air leak as a complication of these procedures reportedly occurs in 3-5 of cases. For lobectomies alone, this accounts for more than 1,500 cases per year. Thus, prolonged air leak is a significant cause of patient morbidity and increased hospital cost.
Thoracic procedures including lobectomy, segmentectomy, wedge and bleb resections are all potentially complicated by prolonged air leak. With current surgical technique and postoperative care, it is the duration of these leaks that often dictates the length of hospitalization. Resolution of these leaks sometimes requires invasive measures, adding to patient morbidity and hospital costs. Any reduction in air leak duration shortens hospital stays, reduces morbidity, and decreases overall postoperative expense.
Numerous surgical adhesive materials introduced bronchoscopically, thoracoscopically, or by direct tissue application, have been used in an attempt to control bronchopleural fistulas (BPF). The most commonly investigated materials include cyanoacrylates and fibrin glue sealants. The use of cyanoacrylates requires meticulous tissue preparation and, despite improvements in compound synthesis, concerns with both aldehyde biocompatibility and local inflammatory response still exist. Fibrin glue sealants require autologous cryoprecipitate preparation or risk virally transmitted pathogen exposure, and no commercial product exists to expedite this process. Crosslinked gelatin preparations, methylcellulose hemostatic agents, injectable bovine collagen and various combinations of these materials have also been studied.
What is needed is an approved method of treating peripheral bronchopleural fistulas that does not have the above stated drawbacks.
It is an object of the invention to provide a method of treating peripheral bronchopleural fistulas
It is another object of the invention to provide such a method that hastens the closure of air leaks.
It is a further object of the invention to provide such a method that is relatively easy to perform, and has fewer biocompatibility and inflammatory problems.
These and other objects arc met by providing a method of treating peripheral bronchopleural fistulas by applying a collagen matrix hemostatic pad (i.e. INSTAT, sold by Johnson and Johnson Medical, Inc., Arlington, Tex.) over an air leak. The method includes the following steps: (1) selecting a peripheral bronchopleural fistula; (2) selecting a collagen matrix hemostatic pad having sufficient size to cover the fistula; (3) aligning the collagen matrix hemostatic pad completely over the fistula; and (4) attaching the collagen matrix hemostatic pad to the tissue surrounding the fistula.